Accurate prediction of competing risks of mortality remains a key component of prostate cancer treatment decision-making. We sought to validate the Prostate Cancer Comorbidity Index (PCCI) score for predicting other-cause mortality (OCM) and cancer outcomes in men undergoing radical prostatectomy (RP).
We sampled 4857 men with prostate cancer treated with RP in the VA from 2000-2018. Risks of OCM, 90-day all-cause mortality (ACM), prostate cancer-specific mortality, metastasis, and biochemical recurrence by PCCI score were assessed using Cox proportional hazards and logistic regression. We compared prediction of 90-day ACM between PCCI and the American Society of Anesthesiology (ASA) score, a validated predictor of short-term mortality.
Over median follow-up of 6.7 years (IQR 3.7-10.3), there was a stepwise increase in risk of OCM with higher PCCI score, with hazards (95%CI) of 1.53 (1.14-2.04), 2.11 (1.55-2.88), 2.36 (1.68-3.31), 3.61 (2.61-4.98), and 4.99 (3.58-6.96) for PCCI 1-2, 3-4, 5-6, 7-9, and 10 + (vs. 0), respectively. Projected 10-year cumulative incidence of OCM was 8%, 12%, 16%, 19%, 26%, and 32% for scores of 0, 1-2, 3-4, 5-6, 7-9, and 10+ , respectively. Men with PCCI 7+ had greater odds of 90-day ACM (OR 3.48, 95%CI 1.26-9.63) while men with higher ASA did not. Higher PCCI score was associated with worse cancer outcomes, with the highest categories driving the associations.
The PCCI is a robust measure of short- and long-term OCM after RP, validated for use in clinical care and health services research focusing on surgical patient populations.
Prostate cancer and prostatic diseases. 2022 Jun 06 [Epub ahead of print]
Michelle S Chen, Lauren E Howard, Shannon Stock, Anna Dolgner, Stephen J Freedland, William Aronson, Martha Terris, Zachary Klaassen, Christopher Kane, Christopher Amling, Matthew Cooperberg, Timothy J Daskivich
University of California, San Diego School of Medicine, La Jolla, CA, USA., Section of Urology, Durham VA Medical Center, Durham, NC, USA., Evergreen Health, Kirkland, WA, USA., Division of Urology, West Los Angeles VA Medical Center, Los Angeles, CA, USA., Divison of Urology, Charlie Norwood VA Medical Center, Augusta, GA, USA., Department of Urology, University of California, San Diego, CA, USA., Department of Urology, Oregon Health Sciences University, Portland, OR, USA., Department of Urology, University of California, San Francisco, CA, USA., Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. .